Pathology of Traumatic Brain Injury

Question 1

Components of Glasgow Coma Scale (GCS)

Answer 1

Eye Response: 1-4
Verbal Response: 1-5
Motor Response: 1-6

15 point scale

Question 2

General neuroexcitation after brain injury and consequences

Answer 2

After CNS injury, massive neurotransmitter release predominantly of glutamate.

Increased NMDA receptors leads to hyperexcitability of brain –> decreased blood flow, hyperglycosis/increased glucose utilization; after brief hyperglcolytic stage however brain becomes hyPOglycolytic–can visualize both on PET

However, glycolytic profiles/ utilization insignificant prognostic tool.

Question 3

What factors determine level of injury from fall?

Answer 3

Height of fall

Hx of ETOH, drugs, age

Question 4

Focal/diffuse lesions and consciousness

Answer 4

Focal lesions NOT related to LOC.

Diffuse lesions go through phases of unconsciousness, PTA/confusion (post-traumatic amnesia), post-confusion/recovery of function.

PTA duration is most important prognostic indicator. Older age associated with longer PTA.

Question 5

Clinical predictors of outcome in DAI?

Answer 5

GCS

Length of LOC

Duration of PTA (most important prognostic indicator)